Development and initial validation of a simplified gestational age score in low birth weight newborns in India

Abstract

Background: Assessment of gestational age (GA) based on the last date of menstrual period is often inaccurate. Scores to predict GA of newborns are difficult to use particularly by health workers. An accurate, easy to use the method of assessing GA, particularly in low birth weight (LBW) babies, is needed to detect and link premature newborns to the appropriate level of care. Objectives: The objectives were (1) to develop a "simplified GA score" (SGAS) by selecting items from 3 standard GA scores that significantly predict the GA as measured by the best obstetric estimate (BOE), (2) to validate the accuracy of SGAS against the BOE, (3) to compare the accuracy of SGAS to assess the GA as compared to the accuracy of GA assessment by the New Ballard Score (NBS), and (4) to assess inter rater agreement of SGAS as compared to that of NBS. Materials and Methods: Both the development and validation studies were cross-sectional studies. In the development study, two neonatology residents trained in the use of the 3 scores assessed LBW (<2,500 g) newborns within 24 h of birth. The residents were blinded to each other's assessment and the BOE (GA obtained from last menstrual period [LMP] and confirmed by ultrasound (USG) to be within 2 weeks of the GA ascertained by LMP). Items significantly predictive of GA in multiple regressions were included in the SGAS. In the validation study, two different neonatology residents trained in the use of SGAS assessed the same LBW newborns within 24 h of birth, blinded to each other's assessment and the BOE. Results: In 171 LBW newborns enrolled in the development study, 4 items (Skin, breast, genitals, and posture) were selected for the SGAS. The prevalence of very preterm (<32 weeks) was similar to the actual prevalence. Agreement between the two ratters for SGAS (Cohen's kappa 0.825) was better than that for the NBS (Cohen's kappa 0.709). SGAS had higher positive predictive value for <32 weeks and for ≥32 weeks to ≤35 weeks as compared to the NBS. Conclusions: SGAS is a promising scale for assessment of GA. It needs further validation by public health nurses and community health workers of low resource settings.

Early identification of preterm neonates at birth with a Tablet App for the Simplified Gestational Age Score (T-SGAS) when ultrasound gestational age dating is unavailable: A validation study

“…Thirdly, we used the dichotomous categorizations of preterm obtained from the two assessments and estimated Fleiss's kappa on this dichotomous classification. Our previous studies have shown that a score of 14 or more is indicative of a term baby [9]. This cut-off was used to generate the dichotomous categories from the two assessments.…”

“…T-SGAS is simple with just a simple 4 item scoring scale with 3 physical and 1 neurological item. T-SGAS was developed by using the most predictive items from the 12-item New Ballard Score (NBS), 22-item Dubowitz score (DWS) and 11-item Meharban Singh (MS) and validated against the Best obstetrics Estimate (BOE) in low birth weight (LBW) newborns in India [9]. Because it showed promising results for estimation of GA in LBW newborn and was easy to by nursing staff in the community it was adapted to a pictorial tablet app (T-SGAS) [8].…”

“…Considering these implementation gaps, we developed a tablet-based pictorial GA assessment tool, the "Tablet based-Simplified Gestational Age Score" or T-SGAS. T-SGAS was adapted from a previously developed and tested simplified gestational age scoring system [8,9]. The aim of this study was to assess the accuracy of T-SGAS in assessing prematurity of newborn, over and above birthweight.…”

Early Identification of Preterm Neonates at Birth With a Tablet App for the Simplified Gestational Age Score (T-SGAS) When Ultrasound Gestational Age Dating Is Unavailable: Protocol for a Validation Study

“…We previously used the NBS, DWS and Meharban Singh scoring system to develop a 4-item simplified gestational age score (SGAS) for use in low birth weight newborns in India [ 13 ]. The 4-item scoring system is as follows: posture (0 to 4), skin (–1 to 5), breasts (–1 to 4), and genitals (–1 to 4).…”

“…The total score was used to define 4 SGAS categories: <32 weeks, ≥32 to <35 weeks, ≥35 to <37 weeks, and ≥37 weeks. The SGAS then underwent initial testing in 171 newborns [ 13 ] and was found to have a high positive predictive value for very preterm (<32 weeks gestation) and moderate preterm (32-35 weeks gestation) neonates compared with the NBS. In our prior study, a score of <14 predicted that a newborn was preterm (GA of <37 weeks).…”